As Drug Deaths Soar, a Silver Lining for Transplant Patients

BOSTON — The surge in deaths from drug overdoses has become an unexpected lifeline for people waiting for organ transplants, turning tragedy for some into salvation for others.

As more people die from overdoses than ever before, their organs — donated in advance by them or after the fact by their families — are saving lives of people who might otherwise die waiting for a transplant.

When Dave and Roxanne Maleham got the call in June that they had long dreaded — that their son, Matt, 38, was on life support after overdosing on heroin and fentanyl — they talked about donating his organs.

“We were trying to think if we could draw any good out of this tragedy,” said Mr. Maleham, pastor at Union Congregational Church in Union, N.H.

Matt, as it turned out, had already registered as a donor on his driver’s license, which came as an enormous relief, almost a gift, to his parents. His donation reminded them of their son’s generosity and good-heartedness, qualities that his addiction had sometimes obscured.

“It absolutely turned things around for me,” Mrs. Maleham said. “Finding out that with his death someone else could benefit was such a joy.”

The impact has been striking, especially in a region like New England, which is in the grip of a heroin and opioid epidemic.

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The scar from Rita Lottie’s liver transplant. “When you have a terminal disease, you look at things differently,” she said.CreditAlexandra Hootnick for The New York Times

So far this year, 69 people in New England who died from an overdose have donated their organs, according to the New England Organ Bank. They account for 27 percent of all donations in the region, up sharply from 2010, when eight donors, or 4 percent, were drug users.

Because doctors can use multiple organs from each person, these 69 deceased drug users saved the lives of 202 other people, according to the organ bank.

Nationwide, more than 790 deceased drug users have donated organs this year, accounting for about 12 percent of all donations. That is more than double the 340 drug users who donated in 2010, or about 4 percent of the total, the organ bank said.

“It’s an unexpected silver lining to what is otherwise a pretty horrendous situation,” said Alexandra K. Glazier, chief executive of the New England Organ Bank, which procures organs for transplant in the six New England states and Bermuda.

Drug users have long been considered high risk because they often carry diseases like H.I.V. or hepatitis C. But at a time of a severe organ shortage, the volume of organs available from overdose deaths has led transplant centers to try to use them instead of throwing them away. With rigorous screening, officials say, the risk of transplanting an infected organ is small. Moreover, they say, hepatitis C can be treated if not cured and H.I.V. made manageable. Either is usually preferable to death.

“We know now that the mortality rate of being on the waiting list for several years is higher than that of getting an organ with an infection that is treatable,” said Dr. Robert Veatch, a professor emeritus of medical ethics at Georgetown University, who has written extensively about organ transplants.

Rita Lottie, a 65-year-old grandmother with liver disease, said she was at first “iffy” about the prospect of accepting a liver from a high-risk donor.

But after a year on the waiting list, Mrs. Lottie was so sick that when a liver whose donor had hepatitis C became available, she eagerly accepted it.

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Dave and Roxanne Maleham had discussed donating organs from their son after his fatal overdose, but then they learned he had registered as a donor.CreditCheryl Senter for The New York Times

“When you have a terminal disease, you look at things differently,” said Mrs. Lottie, a retired teaching assistant who lives in northern New York. In April she received a liver transplant at UMass Memorial Medical Center in Worcester, Mass.

“I thought, if it gives me five to 10 more years, that’s more than I would have had,” she said.

So far, she has not developed any infections and is healthier than just before the transplant. She enjoys her grandchildren and gardening, and is looking forward to her 46th wedding anniversary.

Transplants were initially associated with deaths from car accidents, which is why organ donors are noted on driver’s licenses. But overdoses (47,000 in 2014) have surpassed car crashes (32,000 in 2014) as the leading cause of accidental death in the United States. The growing numbers of overdoses from synthetic opioids like fentanyl and carfentanil have only heightened the drug toll.

Drug users are now the fastest-growing category of donor. They rank fourth, behind donors who died of strokes, blunt injuries and cardiovascular problems.

But even as drug users are making a life-or-death difference for some recipients, the need for organs remains vast.

There are 120,000 people on the national wait list for transplants. While 85 people receive one every day, 22 others die every day before a match is found.

One advantage of drug users as donors is that they tend to be younger and healthier than other donors, said Dr. David Klassen, chief medical officer for the United Network for Organ Sharing, which administers the nation’s organ procurement network.

Survival rates for recipients of a pancreas, liver or heart from drug users from 2012 to 2014 were similar to those for recipients whose donor had no history of drug use, according to the Organ Procurement and Transplantation Network.

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Containers labeled for various organs at the New England Organ Bank in Waltham, Mass.CreditM. Scott Brauer for The New York Times

Dying of an overdose, which usually occurs when oxygen cannot reach the brain, does not affect kidney function or other organs. The drugs and blood are flushed from the organs when they are removed from the body.

Still, the Public Health Service considers organs from drug users to be high risk, as it does those from prostitutes, people who have been incarcerated and men who have had sex with men. For many years, patients with H.I.V. and hepatitis C were not even considered potential donors and their organs were thrown out, and some surgeons still hesitate to use them.

“Putting a virus into a person is repulsive to many clinicians,” Dr. Veatch said. And in a litigious era when defensive medicine is the norm, some doctors reject organs from high-risk donors.

While the transmission of infection is rare, it does occur. From 2006 to 2015, according to the Organ Procurement and Transplantation Network, 249 of 174,388 recipients contracted a disease from their donors, and 71 of them died.

Some were high-profile cases. In 2007, a single donor transmitted both H.I.V. and hepatitis C to four organ recipients. It was the first time in 20 years that H.I.V. had been conveyed in a transplant, and it underscored the problem of tests failing to detect viral diseases if they are administered too early.

But with intensive screenings, a thoroughly informed consent process involving the recipient and the ability to treat most resultant infections, more centers are accepting high-risk donors.

“The severe shortage of organs and imminent risk of death in some patients are the basis for offering a hep C positive organ to a patient who is not hep C positive,” said Dr. Adel Bozorgzadeh, chief of the division of organ transplantation at UMass Memorial, which has a reputation for performing transplants on high-risk patients.

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Alexandra K. Glazier, chief executive of the New England Organ Bank, with cases used to transport kidneys.CreditM. Scott Brauer for The New York Times

“With recent availability of highly effective treatment for hep C, it makes sense to consider this approach for the occasional patient who otherwise has, objectively, a very high risk of dying,” he said.

Recipients must be told if they are being offered an organ from a high-risk donor. Whether they consent often depends on how sick they are. If they decline, they do not lose their place on the waiting list, although it may be quite some time before another match comes along.

David Sellers, 51, who works with computers in Worcester, has been waiting for a kidney for a year. He is not yet on dialysis and says he is in fairly good shape, although exhausted at the end of the day.

“If I were presented tomorrow with a high-risk donor, I would opt not to accept it,” he said. “I don’t want to introduce another opportunity for disease to ravage my body.”

Still, he acknowledged that as his condition deteriorated, he might become more receptive to “whatever I could get.”

Arthur L. Caplan, head of the division of medical ethics at New York University’s Langone Medical Center, said potential recipients of high-risk organs had to grapple with what he called “the coercive nature of imminent death,” meaning the sicker they are, the more they may feel they have no real choice.

“If you’re facing death and someone is throwing you a potential life preserver,” he said, “the less interested you are in who made the life preserver and where it came from.”

A version of this article appears in print on , on Page A1 of the New York edition with the headline: Amid Rising Drug Deaths, Silver Lining for Transplant Patients. Order Reprints | Today’s Paper | Subscribe